Trust and Science: How Do We Communicate with Parents About Vaccines?

Overview

Imagine you’re at a dinner party. Someone starts telling you that she heard all this hype about global warming. Pollution, she read, has nothing to do with climate change and scientists and experts simply don’t agree. You start wondering: where is she getting her information? What experts? Isn’t it true that the vast majority of scientists DO agree based on a preponderance of the science?

Now picture that same dinner party. A friend starts telling you how she’s decided not to vaccinate her new baby. Or, she’s talking with her mommy group to decide which vaccines to pick and choose because there are just “too many” and that just doesn’t seem safe. Perhaps she goes on to say she knows several children at her son’s school who have autism and she heard one mom say her child was perfectly normal before getting vaccinated. Now what do you think?

Questioning vaccines

Even as public health educators or advocates, we have to live in the real world. Chances are, you may be a parent yourself. The point is, we need to be able to relate to and empathize with the average young parent today. And when it comes to vaccines, doubts are becoming a common theme. The statistics speak volumes. Recent polls indicate that 1 in 4 parents still think vaccines are linked to autism, despite multiple studies showing this theory is absolutely not true. About 3 in 4 parents are worried about vaccine safety—even if they follow the standard recommended vaccination schedule. And now, 1 in 10 parents are also delaying or postponing at least some vaccines. Why? Partly, multiple vaccines are causing stress in parents. Let’s face it, bringing in a baby in for shots is no picnic. And there are those omni-present dinner party conversations and hours spent online trying to make sense of what you hear and read.

Instead of relying on pediatricians for advice, more and more, parents are going online to websites, message boards, and mommy blogs. Often, these sources allow us to find like-minded people, validate our own concerns, and gain confidence in the gut feeling that vaccines could be harmful. With less childhood disease visible in our communities than in our parents’ generation, it might just seem logical that vaccines could be more risky for a child than taking a chance on the diseases they protect against.

You’d have to live on another planet if you haven’t heard at least some of the many ills attributed to childhood vaccines—but without merit. Unfounded claims abound on the Internet about “toxins” (like mercury or aluminum), or overwhelming an infant’s immune system, and even that the diseases themselves are safer than the vaccines. Emotionally compelling, but unsubstantiated, personal anecdotes often substitute for facts.

And the hardest to evaluate: poorly-conducted and inconclusive research studies, held up by some groups as “proof” of vaccine dangers. Review of such studies shows that they do not meet a fundamental scientific principle. That is, other scientists cannot replicate their findings. Sadly, once such information is posted online, it takes on a life of its own, being shared or quoted widely—often without a knowledgeable expert to refute false claims.

Lining up against science

The fact is, vaccines have become ground zero for many parents to line-up against science. Just like global warming, over 20 years of scientific evidence overwhelmingly shows that vaccines are among the very safest medicines in the world. The diseases they prevent that used to sicken, injure and kill healthy American babies only remain relatively rare because immunization rates remain high.

What health officials worry about is the erosion of “community immunity”, (a more sympathetic term than “herd immunity”). Simply put, if, for example, 90% or more of the people in a given community are vaccinated, they create a protective barrier to help the few vulnerable unvaccinated people from getting a disease. The unvaccinated could include anyone allergic to a vaccine, those going through chemotherapy or who have compromised immune systems, pregnant women, and newborns too young to be vaccinated. Diseases many parents think of as benign (like chicken pox) could be fatal to vulnerable neighbors, coworkers, friends, teachers, etc who are unable to get vaccinated.

What we’re seeing more of today is communities where some schools have 30% or more unvaccinated children. So, while the overall US vaccination rate is high, pockets of unvaccinated kids in a school, playgroup or day care jeopardize community immunity. It can be difficult to explain that even vaccinated are at greater risk if community immunity erodes. That’s because vaccines are great protection, but like most things in life, they’re not an absolute guarantee. Some vaccinated children don’t get as robust an immune reaction as others. This does not mean vaccines don’t work. But parents who really do want to be informed should understand that more unvaccinated children in in a community can put many others at risk for a preventable disease.

The Centers for Disease Control and Prevention (CDC), reports that at least 214 kids in the U.S. contracted measles in 2011, the largest number in 15 years. In 2010, California had the largest whooping cough epidemic since 1947 with over 9,000 cases and 10 infant deaths. A 2008 measles outbreak happened in San Diego as a result of one family’s European vacation and their unvaccinated child spreading the disease to others back home. These are telltale signs of eroding community immunity. Remember, with daily global travel, diseases we think of as “distant” are only a plane ride away.

Taking action

Our generation has an unprecedented access to health information online. This makes us active partners when we see the doctor. We should encourage parents to bring questions or studies to their pediatrician to start a constructive conversation about their concerns. But it’s also incumbent on our medical community to listen. The balance can be daunting.

We hear from clinicians who are frustrated by hearing the “same old” unfounded arguments when they bring their children in for shots. We need to recognize the broad brush strokes of doubt targeting popular “villains” (which can include government public health, medical, or scientific experts). We’ve become skeptical society—of profit motive, of authorities. In short, it’s hard for parents to know just who they should trust. So how can the public health and medical community do to help?

Refer parents to reputable websites. The theory (still referenced on some sites) that the MMR vaccine might be linked to autism stems from the now-debunked 1998 study by British gastroenterologist Andrew Wakefield. Dr. Wakefield’s article was retracted by the journal when it was found to be fraudulent and Wakefield lost his medical license in the UK. Multiple studies have found no science that autism is caused by any single vaccine, combination vaccine (like the MMR vaccine), or by the mercury-containing preservative thimerosal. As a precaution, thimerosal was eliminated from all routine childhood vaccines in 2002.

Refer to the facts. We can help counter misinformation about side effects from vaccines or vaccine ingredients.

Get real. Parents need something that’s not abstract to understand what the diseases are that vaccines prevent. One great source is called ShotbyShot.org. There’s nothing more compelling than hearing first-hand from other parents’ experiences.

Urge parents to bring their questions to the doctor. You can’t stop people from going to Dr. Google, but getting additional advice can’t hurt. Studies indicate that for most parents, pediatricians are still one of the most trusted sources.

Remind parents that they want the doctor’s best medical advice—they don’t want to settle for being placated just because they’re nervous. Opinions differ on how strongly doctors should adhere to the standard vaccination schedule. The doctor visit can be an opportunity for a productive discussion. Parents need to feel heard and validated that the clinician is taking into account their child’s individual health concerns. Some pediatricians—out of simply trying to accommodate a parent’s fears—will go against their own best medical advice in order to keep the peace. By maintaining a trusting relationship, it’s more likely that the doctor can talk about the risks of delaying vaccines.

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